Intro
Like eating, drinking, breathing, we need sleep to survive.
A big part of our problem is we aren’t living in a world that’s set up to allow us to sleep well.
Sleep isn't something we do as much as it is something that happens to us. A lot of it is about letting go, getting out of our own way, and training our bodies to recognize the cues at night, and throughout the day, that tell it what it should be doing, and when.
When we brought people into the lab and shot a live cold virus into their nose, people who typically get fewer than 6 hours of sleep per night are four times more likely to develop a cold then those who usually sleep more than seven hours per night.
Sleep is one of the areas where we can see a huge transformation with a few concrete changes.
Sleep often ends up being the last thing on our to-do list. Really, it should be the first. It's an "essential element" that we all need for health, longevity, and vitality, and it's not one we all have equal access to.
Sleep is universal yet personal. There are some baseline things that are true about sleep for all of us ... But there's no single, all- encompassing model that works for everyone.
Sleep is amazing medicine..... Science is showing us.. good sleep boost the immune system. It regulates metabolism. And makes you happier. It makes you a better, more empathetic partner and more patient parent. It can prove your productivity and creativity at work and boost your energy so you can actually squeeze in that extra (or first) workout during the week. It sharpens the mind and can actually clear toxins out of the brain that build up over time, including those thoughts to play a role in the read neurodegenerative diseases.
Sleep basics checklist
Is your room dark?
Is your room cool?
Is your bedroom clutter - and distraction - free?
Is your phone attached to your hand?
Do you know your sleep data?
P 2
A really creative research study found that participants who went camping in the Colorado wilderness for a weekend and weren't allowed to use artificial lighting at night (no flashlights, headlamps, nothing) shared a 69% shift in their biological sleep/wake rhythm compared to those who stayed home.
p 3
When do you wake up?
p 4
Your body makes insulin in anticipation of a meal, and melatonin in anticipation of sleep. If your routine is erratic, your body gets confused about what it needs to be doing and how it should be using its resources.
Figuring out a consistent wake up time is the number one thing I do with people who come to the sleep clinic. And that's because it's the most powerful regulator of the two natural processes that cause sleep.
p 5
You have two main "drivers" of sleep....homeostatic sleep drive and circadian rhythm.
Your homeostatic sleep drive is essentially "pressure" for a sleep that builds up during the longer you're awake.
p 6-7
Your circadian rhythm is, most basically, your "Master clock" that governs the rhythm of all your bodies processes -- including sleep and wakefulness.... All of this lives deep in the area of the brain called the suprachiasmatic nucleus, or scn, which is found in the hypothalamus, a small but influential area of the brain that controls everything from the release of hormones, to thirst, to body temperature, and more. It also determines your "alertness rhythm" throughout the day. In general, our alertness tends to spike higher in the morning, dip in the afternoon, rebound slightly, and then wane slowly through the evening until we need to go to sleep.
The "master clock" regulates us in two main ways.
The first is internal-- you're master clock's rhythms are shaped by your genes and the proteins they produce. This is something you don't have much control over. You can certainly push against your genetic circadian preference but some people find it more challenging than others.
The second category of factors that influence your circadian rhythm are external. The "arousal systems" in your brain are
p 8
at all times, gathering information from your surroundings. Darkness is a huge trigger for sleepiness. First, photo receptors within the retinas sense light or the lack thereof. That information travels through neural pathways in the brain to the hypothalamus...which notes the waning of the day and pings the penal gland to begin releasing melatonin, the sleepiness inducing hormone that's been pilled and bottled and put on shells all over grocery stores and pharmacies to help the sleep challenge make it to dreamland. It works in reverse, too: when you're exposed to light, the opposite happens--melatonin release is suppressed.
There are all kinds of "landmarks" throughout your day that give unconscious yet powerful signals to your brain about where exactly you are in your twenty-four-hour cycle, a process called entrainment. These elements of your environment or routine become something your body not just responds to, but anticipates. It does this to optimize, to maximize your biological efficiency.
p 9
.. our circadian rhythms are a product of a swirl of factors... The wide variation that we see in human circadian rhythms is interesting... There may be other reasons, not related to sleep, that circadian rhythms vary: circadian clocks play a role in many other processes including metabolism, but also the immune system.
p 10
There is now an entire field of study surrounding this: chronomedicine.
Can we "reset" circadian rhythms?
p 11
A phase delay is, essentially, when you're circadian rhythm is not in line with the rest of the world.
We can try light therapy in the mornings. Melatonin supplements at night.
A stimulant called modafinil.
We could do chronotherapy.
p 12
.. when we push you the other direction and sleep deprive you until you want to go to sleep at the right time.
May be able to slowly shift your schedule
it may not work very well.
p 13
extreme of a phase delay is extremely uncommon
We have behaviors that we engage in, for lots of valid reasons, that perpetuate a sleep struggle... A lack of structure around our wake time compounds the problem, keeping our dysregulated sleep cycle rolling along.
p 14
When people come into my clinic, the first thing I tell them is to pick a wake up time and stick to it -- 7 days a week. Consistency is key -- your body crazy, and it can have powerful effects.
p 17
By keeping a stable wake time, you remove some of the uncertainty and randomness from the morning.
p 19-21
Choose a wake up time.
Program your alarm or phone for your chosen time now.
As soon as you wake up come and get up and open the blinds.
Reward yourself for waking up.
Fill out your sleep diary.
If you keep snoozing.... Put the alarm clock across the room.
Make sure your reward is really rewarding!
p 24
Your body's stress response, and how you manage stress, can impact your sleep. But even more powerful, your sleep determines how well you handle stress. Studies we've run in the lab have discovered there are daytime experience of stress is not always a great predictor of sleep. In fact, you can have a really high stress day followed by a great night of sleep.
p 25
Couple of exceptions: first, the stressful event happens close to bedtime that will certainly impact your ability to shut your brain off for the night. And second, if the stressor is severe, well, that'll probably affect you that night! Overall, your mind and body can cope quite well with everyday stress -- even when it feels intense. For instance, peak and recovery stress is something your system was built for and can even be healthy for yourselves -- it triggers a cleanup process where the body sheds old, damaged, and senescent (dead) cells.
p 26
Today's stress will not preclude you from getting great sleep. Data from research studies that capture participants daily stress and nightly sleep for days on end actually indicate that the stress- sleep impact runs more strongly in the other direction: poor sleep or short sleep makes you more vulnerable to stress. Studies we've run in our own lab, as well as research from others that show that when people don't get enough sleep, they experience their days as more stressful.
p 28
Under periods of less sleep, we are more likely to get into conflicts, including with those we love the most.
p 29
Sleep loss can also do a number on your health behaviors, including dietary choices, leading us to make ones that may not be great for our sleep (or health) later on.
p 30
Executive control makes sure your goals and actions are in alignment. And what we see with sleep deprivation and lab studies is that for participants, the executive control basically "turns off".
Under stress, we make the same kind of food choices we do under sleep loss: we crave Betty and sugary foods. That's no accident.
p 31
There's a biological reason that our bodies are crying out for this kind of stuff when our stress response is churning: because it dampens the cortisol response. When you have a high cortisol response going on, your body prefers those high fat, high sugar substances because they have kind of a "medicine" for stress. Studies have unearthed that while most carbohydrates will actually help you fall asleep faster, onlu certain types will help you stay asleep... Complex carbs can stabilize your sleep patterns
p 32
Stress, we now know, when it's constant, ages you at the cellular level. It wears down here telomeres, they protective caps at the ends of your chromosomes that play a significant role in determining the cellular aging of your body. And guess what? Insufficient sleep does that, too.
p 33
Just as the sleep stress cycle can be exponentially damaging, it can be exponentially beneficial when you use it to your advantage. The less stressed you are, the more you can stick to your daytime choices that don't undermine sleep. The more sleep you get, the more capacity you have to make those choices.
p 35
There are two major things that can be in play with higher levels of stress get in the way of sleep, cortisol and the sympathetic nervous system.
Cortisol is a metabolic hormone: it ensures that there's adequate glucose for your cells to use. Essentially, cortisol helps regulate energy.
p 36
Experiencing frequent stress triggers and consistently elevated cortisol starts to become a problem for sleep.
Cortisol is also part of your awakening response
p 37
In a healthy, balance system, there's an appropriate toggling that happens between the sympathetic nervous system (fight, flight, freeze) and the parasympathetic nervous system (rest and digest). If we're carrying around a lot of stress, it's hard to disengage the sympathetic and amp up the parasympathetic at bedtime.
p 43
Research shows that mindfulness meditation can provide some of the same restorative benefits as sleep does.
We can't go full tilt all day long and then switch off at night. How you live during the day is where the issues originate - - it's why we end up with high cortisol, and overactive sympathetic nervous system, or a subconscious desire to stay up too late.
p 45-47
Make time for sleep and for breaks
Take five "micro brakes" during the day.
Set a timer.
"Anchor" your break to an existing staple in your routine
p 49
This valley of low energy we usually experience through mid afternoon is perfectly normal. It's another program part of your circadian rhythm. Your internal clock releases cortisol in the morning to jumpstart you, and then hit you with a nightcap of melatonin in the evening to wind down.
p 54
The half life of caffeine is around 6 hours.
p 56
With people who are struggling with sleep for whatever reason, the general recommendation is: don't nap. But if you do need to nap, keep it to 20 to 30 minutes, the magic length of a good nap.
p 57
Make sure that you're not "stealing" from night time sleep.
Non-rem sleep comes first
N1 stage sleep is light your sensory system isn't lost to the world
N2 this characterized by what we call "sleep spindles": bursts of neural activity that occur as you're sleeping.
N3 slow wave sleep, deep restorative sleep.
p 58
REM sleep comes last. This is where you do your dreaming. You are out of slow wave sleep now; your sleep is lighter and you're closer to consciousness
The length of each phase of your sleep changes over the course of the night. The cycles are dynamic, and they change from cycle to cycle as you progress through the night.
p 59
"Sleep inertia". We don't always make it all the way into deep sleep within 20 to 30 minutes, but when sleep deprived, we tend to drop into slow wave sleep faster.
Your circadian rhythm might drag you down a bit in the afternoon- - there's nothing you can do about that
Optimize your schedule. Think about how you might structure your day to take better of better advantage of your peaks of alertness and take pressure off yourself during your circadian dip.
p 60
Meditation...mindful meditation in particular is an effective tool for preventing stress build up over the course of the day.
Move your body. There is data showing that the effects of exercise on important cognitive processes, like working memory, are similar to the effects of caffeine.
p 61
You don't need coffee to take a break.
Switch up your routine.
p 62
Stick your head in a freezer. A mild shock to the system might be exactly what you need today at 3:00 p.m. to beat their circadian dip you're feeling. Cold and packs the nervous system.
p 63-64
We have growing evidence that intermittent stress exposure, known as hormetic stress, can give a positive boost to health and longevity.
Distinction between challenge stress and threat stress. Hey gazelle running for its life, the lion just behind. The gazelle is experiencing threat stress, the lion is experiencing challenge stress.
p 65
Worry early. You saying just our thoughts, we can time travel into the past or future, reliving or rewriting events that have already occurred, inventing various scenarios and feeling them with vivid century detail. We drive up our own stress levels for no reason at all and no associate benefit. We are really, really good at this.
p 66
And rumination--when you replay events from the past you wish had gone better, as opposed to worry, which is more future focused -- is, we believe, one of the major pathways that perpetuates insomnia.
p 70
The more you tend toward high rumination, the more affected you're going to be by events in the day you perceive as negative, stressful, or threatening.
We're social by nature -- even the introverts - and we are very sensitive and susceptible to interpersonal slights.
Why are some people naturally more ruminative than others? There's a whole cornucopia of factors. But there is also incredible neuroplasticity in the human brain.
p 78
When your own mind is the problem.
The contents of a ruminations and our worries do not appear from nowhere. We pull them from the world around us and from our past.
p 81
There is no magic switch to completely turn off rumination.
Strategy #1 worry early, set aside a specific chunk of time for something very important to your well-being.
p 82
Recommend choosing a time during the mid to late afternoon because it's early enough it won't impact your ability to sleep later but it's not so early you still have a big chunk of day left to go produce rumination creating foyables
p 83
If you noticed during the day that you find yourself worrying, you can say to yourself, look, you need to just postpone this to the next worry time -- you have it scheduled.
p 84
Constructive worry.
On a piece of paper create two columns: problems on the left side and solutions on the right. As soon as you're able, put it right by your bed and say to yourself, "I have come up with the plan for these things for when I'm at my best, sharper than I am in the middle of the night. I can wait to do these until tomorrow because I have a plan."
p 85
Try "trainspotting": picture yourself on a platform watching the thoughts arrive and park, arrive and depart.
p 86
Neuroscientists have discovered that the number of discrete things you can think about at once is about three. After that, stuff just flips off your radar.
Visualization to replace negative thought loops, try this:
Start with progressive muscle relaxation.
p 87
Visualize a place that serene for you. It can be a real place you know from memory, or an invented place.
Focus on the sensory details of this place. Move your mind from one sensation to the next.
p 91
What we needed to work on with him was creating a time and ritual necessary for him to go to sleep naturally, in a way that worked within the context of his life.
p 92
We value performance and productivity over health and well-being -- often ignoring the fact that those two things are, in fact deeply linked.
p 93-94
There's a delicate balance between you're arousal system and your sleep system. Both are both neurochemical systems in the brain: they each have a network of neurons associated with them. The wake side of the equation, we have wake-promoting neurons in the brain stem and the hypothalamus and elsewhere that release histamine, dopamine, serotonin, and norepinephrine. On the sleep side, we have neurons in the ventrolateral preoptic nucleus of the hypothalamus that release GABA. GABA receptors are they primary targets for things like alcohol and anti-anxiety medications. These two systems are what we call "reciprocally inhibitory." In other words, when one is active, the other one is suppressed. At the moment of "falling asleep," what you're actually feeling is these two systems battling each other. An example where this switch seems to be broken is seen in people with narcolepsy.
The sleeping brain is incredibly complex. However, for our purposes, but what finally tips the balance to those two sleep processes we've been talking about: homeostatic sleep drive and circadian rhythm. If you're asleep pressure has built up enough and your circadian rhythm is nicely aligned, you'll finally flip over into asleep and stay there
p 95
One of the ways this happens is through the production of melatonin, often called the "sleep hormone."
Melatonin is a natural hormone produced by the pineal gland. Another hormone produced primarily in the raphe nucleus of the brain is serotonin, which is sometimes called the body's natural happiness hormone. Plus our regulated, to a certain extent, by light.
Melatonin doesn't put you to sleep all on its own. Melatonin is like a thumb pressing down on the sleep side. So the thing to consider is that the stuff you do in the hours before bed can either aid and melatonin production or get in its way.
p 96
We are based in artificial light, often right up until the time we go to sleep. Limiting light exposure in the readout to bedtime is a good idea.
p 97
The blue light issue is probably a fairly minor one for most people. Sometimes what you're doing in your blue light emitting device is actually relaxing. Its that we've become too engaged in them. The reward system in your brain is activated by the design of the social --media apps.
p 100
The good news is that lack of THC or melatonin or whatever supplement you are taking is not the reason you are having sleep problems.
One huge reason people have sleep problems has to do with the expectation of what it means to fall asleep going to sleep means letting go. It can be hard to make this transition, especially when you're holding on to vigilance from the day.
P 103-112
The Sweet spot is that lower right-hand wedge, of positive low arousal: calm. Grateful. Tranquil. Content.
Set aside two hours for the wind down.
Stop doing work.
Stop social media.
Stop drinking
Recipe for a great wind down:
Take a bath or shower.
Read or watch TV
Deep breathing
Customize your own list
The wind down isn't about specifically what you do. It's about that you have to make the time. The bottom line is you can't have it all. You will not be able to pull to it right until you want to turn off and then get great sleep.
P 122
When people have chronic sleep issues, it frequently turns out to be the case that they've established a conditioned response to the bed that's the exact opposite of what they want. This is called conditioned arousal.
Your conditioned response is not working against sleep. We need to kill the association between anxious wakefulness and the bed.
p 123
#1. Stabilize your wake time and stick to it.
#2. Don't get in bed unless you're sleeping and if you can't sleep, get up.
p 127
Writes down the stuff you're thinking in the middle of the night and then look at the evidence about how we felt and performed the next day. It makes a little easier to see that those thoughts aren't usually correct. Our thoughts shape our emotions, and if so if we're being tyrannized by untrue beliefs in the middle of the night, it's time to bust these myths we're telling ourselves.
p 128
So, the next time we're in bed and stressed about being unable to fall asleep, remember that it will be okay. But the key here is that when you're awake and mentally aroused, do you need to physically get out of bed. But I advise people to do is go back to one of their wind down activities.
You can't think yourself to sleep.
p 129
Cognitive behavioral therapy.
The central tenant here is that thoughts, behaviors, and emotions are all linked. Often, the sleep problems we encounter stem from learn patterns of unhelpful behaviors. It means if we give people the knowledge and the tools in the clear path forward, they can indeed change their sleep.
p 130
We're focusing on these behavioral basics that can do immediately and that can have a big impact: like stimulus control, which is what we've been talking about and what you going to start doing. Because one of our major behavioral based problems is that we have this broken relationship with our bed. We've eroded that strong association we once had bed with sleep.
p 132-137
#1 don't get into your bed until you're sleepy.
#2 don't do other things in your bed.
#3 give it a shot.
#3 if you're up, get up!
#4 stick with it
What if I can't get out of bed?
Set all the way up!
Move to the other side of the bed!
When you have a sleep partner can be challenging. Consider going to a "quick break."
Utilize an "evening nook".
p 141-142
Calculate your sleep efficiency.
How much time do you spend actually sleep compared to how much time you give yourself to sleep.
Sleep opportunity is the period of time from when you first get into bed at night too when you wake up for the last time in the morning. Sleep efficiency is measured by asleep time divided by sleep opportunity time. Generally, we want to see a sleep efficiency of at least 85%, or higher.
p 147
Sleep restriction: build up that sleep pressure
We teach your body how to sleep again: went to sleep, where to sleep, and how to "let go" into sleep more quickly and easefully. We reduce your sleep opportunity down to more precisely match how much you're actually sleeping on a typical night; we are not wanting you to wake up earlier..... Less time in bed.. each person needs to establish their own schedule though it may be different from a partner's schedule.
p 156
Our sleep needs change as we age; they change with illness or parenthood, with new jobs and new places. Be flexible and aware of yourself and your body's needs in part of this.
p 159
Sleep researchers are discovering evidence that up until the 1800s, it was much more common for people to have "bi-phase" sleep, or to sleep in two distinct segments.
p 160
And they early 1990s, sleep researcher Thomas Wehr ran an experiment where participants live for a month and then environment with a "short photoperiod": only 10 hours total of light, as would have naturally occurred for pre-industrial humans in many parts of the globe. He found that within just a couple of weeks, people sleep episodes expanded and then divided into two symmetrical segments with a one-to three-hour wake window in between them.
It may help to know that wee-hours wakefulness is not inherently bad, unusual, or a clinical indication that something is "wrong".
p 164
For some, full-on sleep restriction will be too extreme, especially outside a clinical setting where I can help you set limits and stick to them.... Try this reverse approach: start bumping your bedtime back, tomorrow gradually close the gap between your sleep opportunity and your actual sleep.. recommend bumping back by half hour increments.
p 165
Sleep restriction hinges on your commitment to our day one practice: choosing a wake-up time and sticking to it. This can get challenging for people as the week goes on and they start to feel the impact of that sleep pressure. Track your data.
p 174
Sleep impacts immune function--a lot. People who got adequate sleep seem to mount a better immune response to vaccinations
Permission to quote; email Aric A. Prather, PhD, May 10, 2025